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51.
Philipp Alexander Bergmann Thomas Lange Frank Siemers Hans-Günther Machens J?rn Andreas Lohmeyer Thomas Namdar Peter Leonhard Stollwerck Stefan Zimmermann Peter Mail?nder 《European journal of plastic surgery》2012,35(1):19-24
Silicone implants have been used for breast augmentation for more than 45 years. Complications, in particular capsular contracture,
occur with an incidence of <10% and up to 60%. We investigated the influence of the surface of breast implants on the formation
of capsular contracture by comparing silicone with titanium-coated silicone. Seventeen smooth saline-filled silicone (group
A) and 14 saline-filled titanium-coated silicone (group B) implants were implanted in female Wistar rats. After 12 and 36 weeks,
the implants and capsules were extracted; histological and immunohistochemical staining was performed. The evaluation of the
capsules was performed by two examiners in a double-blinded manner. Histologically, no significant difference in total capsule
thickness was found. There was a significant difference in synovial-like metaplasia layer (SLM) thickness between groups A
and B (p = 0.041). Regarding implantation time (12 vs. 36 weeks), a significant difference was found in SLM thickness (p = 0.021). Immunohistochemical staining indicated a significantly lower infiltration with inflammatory cells in group B. A
significant correlation (p = 0.019) between a thick SLM layer and inflammatory cell infiltration was detected. Titanium-coated silicone implants reduce
SLM thickness and capsular inflammatory cell infiltration. These findings postulate that titanium-coated silicone implants
might point out a new chance in the prevention of capsular contracture. 相似文献
52.
Maximilian Eder Stefan Raith Jalil Jalali Daniel Müller Yves Harder Martin Dobritz Nikolaos A. Papadopulos Hans-Günther Machens Laszlo Kovacs 《International journal of computer assisted radiology and surgery》2014,9(4):541-549
Purpose
The diagnostic use of computer tomography angiography (CTA) to identify perforating blood vessels for abdominal free-flap breast reconstruction was extended to estimate the three-dimensional (3D) preoperative flap volume and to compare it with the real intraoperative flap weights in order to (1) evaluate the accuracy of CTA-based 3D flap volume prediction, and (2) to analyze abdominal tissue estimation for required breast volume reconstruction.Methods
Preoperative CTA was performed in 54 patients undergoing unilateral breast reconstruction with a free, deep, inferior epigastric artery perforator flap. 3D flap volumes ( \(\hbox {cm}^{3}\) ) based on CTA data were calculated and compared with the actual intraoperative flap weight (g). In addition, a breast volume to flap volume ratio was calculated to analyze whether the estimated 3D abdominal flap volume would match that of the breast to be removed.Results
40 CTA data sets (74.1 %) fulfilled the technical requirements for a reliable determination of flap volume. 3D CTA flap volume prediction showed no relevant differences to the actual flap weight (p = 0.44) and high correlations (r = 0.998, \(p < 0.001\) ), allowing a prediction accuracy within 0.29 \(\pm \) 3.0 % (range: from \(-\) 8.77 to 5.67 %) of the real flap weight. Significantly larger flap volumes were harvested compared with the actually required breast volumes ( \(p < 0.001\) ), leading to an average of 21 % of the remnant flap tissue potentially being discarded.Conclusions
CTA-based 3D flap volume prediction provides accurate preoperative guidelines concerning the needed amount of abdominal tissue that can be harvested to achieve acceptable symmetry. 相似文献53.
Prostaglandins are said to influence T and B cell function by inhibiting the generation of interleukin 2 (IL 2) and the formation of suppressor lymphocytes. After bone marrow transplantation, patients usually have a profound immunodeficiency that persists in recipients with chronic graft-v-host disease (GVHD) and generally resolves in long- term survivors without GVHD. In vitro tests of lymphocyte function such as allogeneic mixed lymphocyte culture (MLC) and cell-mediated lympholysis (CML) have been shown to be impaired in many patients. We postulated that prostaglandin E2 (PGE2) plays a role in the impaired in vitro tests. To test this hypothesis, we studied in vitro tests in the presence of PGE2 antagonists, indomethacin, and anti-PGE2 antiserum with cells from 22 short-term patients (less than 100 days postgrafting) and 32 long-term survivors with or without GVHD. Results show that blockade of PGE2 release by indomethacin and anti-PGE2 significantly (P less than .01) enhanced the MLC (+67%) and the CML responses (+10.5%) of cells from long-term survivors with chronic GVHD but not from those of long-term, stable recipients. No enhancement of MLC and CML activity was observed with cells from donors of long-term recipients. In patients shortly after marrow grafting, enhancement in the MLC was not significant. However, CML activity in this patient group was significantly increased (+12.5% in recipients with no GVHD, 8.5% in those with acute GVHD, P less than .01). Indomethacin also suppressed the activity of nonspecific suppressor cells in patients with chronic GVHD. When cells from patients with chronic GVHD were treated with recombinant IL 2 and IL 2 combined with indomethacin, it was possible to get an additional augmentation of lymphocyte proliferation after the addition of indomethacin to IL 2-treated cultures. Thus it is very likely that PGE2 inhibits T lymphocyte proliferation, not exclusively by inhibition of IL2 production or activity. We conclude that PGE2, among other factors, may play a role in the pathogenesis of the immunodeficiency after transplantation. PGE2 does not act primarily by interfering with IL2 but presumably by inducing a suppressorlike activity. 相似文献
54.
Arcese W; Goldman JM; D'Arcangelo E; Schattenberg A; Nardi A; Apperley JF; Frassoni F; Aversa F; Prentice HG; Ljungman P 《Blood》1993,82(10):3211-3219
We studied the clinical course of 130 chronic myeloid leukemia (CML) patients (89 males and 41 females) in the European Bone Marrow Transplantation Group (EBMT) registry who received transplants before January 1, 1988 and who subsequently had evidence of recurrent leukemia. All patients had received a pretransplant conditioning regimen including total body irradiation (TBI). The first evidence of relapse was cytogenetic only in 74 (57%) patients and hematologic in 56 (43%). The overall actuarial survival from relapse was 36% at 6 years, with a significantly higher proportion of survivors among female patients (53% v 30%; P < .002). In univariate analysis, the 6-year probability of survival was 52% for patients with cytogenetic relapse and 30% for patients relapsing in chronic phase (CP), while no patient who relapsed in advanced phase (AP or BC) survived more than 3.5 years from relapse (P < .0001). The actuarial survival of patients relapsing before 6 months, between 6 and 12 months, and later than 12 months after transplant was 27%, 26%, and 45%, respectively (P < .002). Among patients with cytogenetic relapse, partial or complete disappearance of Ph-positive cells occurred in 40% of untreated patients and in 42% of those treated with interferon (IFN). However, IFN therapy significantly delayed progression toward hematologic disease. Cytogenetic responses were observed in 25% of patients who received IFN for relapse into CP, while only one minor cytogenetic response was reported in patients on conventional chemotherapy. For patients presenting with cytogenetic relapse as well as for those in hematologic relapse, IFN therapy significantly improved the 2-year probability of survival. However, long-term survival for IFN-treated patients in either group was not different from long-term survival in comparable patients not receiving IFN therapy. Twenty-nine patients of this series underwent a second bone marrow transplant (BMT) and the projected survival at 4 years after the second transplant is 28%. In multivariate Cox regression analysis, four factors remained significantly associated with survival: disease phase at relapse (P < .0001), duration of time interval from BMT to relapse (P = .0001), interferon therapy at relapse (P = .0024), and patient sex (P = .0032). This retrospective study provides evidence that some patients who relapse after BMT may benefit from treatment with IFN; a second BMT may offer the chance of cure. Data from this analysis may be useful in designing future prospective trials on posttransplant CML relapse. 相似文献
55.
56.
Sφren S Olesen ;Jacob Juel ;Carina Graversen ;Yuri Kolesnikov ;Oliver HG Wilder-Smith ;Asbjφrn M Drewes 《World journal of gastroenterology : WJG》2013,19(42):7292-7301
Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge.Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders.An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established,the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive.Consequently,the management of pain by traditional methods based on nociceptive deafferentation(e.g.,surgery and visceral nerve blockade)becomes difficult and often ineffective.This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis.Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source,which should be reserved for special and carefully selected cases.In this review,we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis.In addition,future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity. 相似文献
57.
Michiel Vaneker Sjoerd PM van Egeraat Marck HTM Haerkens Oliver HG Wilder-Smith 《Disability and rehabilitation》2013,35(9):535-536
Aim.?To study psychological well-being (health-related quality of life) in a population of adults 20 years and over with hearing impairment (HI) and its relation to audiological factors, consequences of the HI, sense of humour, and use of communication strategies.Subjects and methods.?Consecutive adults (n = 343) at the outpatient Unit of Audiology of a Norwegian university hospital answered the Psychological General Well-being inventory (PGWB), Hearing Disability and Handicap Scale (HDHS), Sense of Humour Questionnaire-6 (SHQ-6), and Communication Strategies Scale (CSS) in relation to an audiological examination and medical consultation.Results.?Mean PGWB index for the whole sample was 81.4 (SD 14.3) and females reported a significantly lower psychological well-being. In multiple linear regression analyses well-being was negatively associated with high levels of activity limitation and participation restriction. PGWB index was positively associated with high sense of humour, but was neither explained by audiological factors nor use of communication strategies.Conclusions.?Psychological well-being was associated with the outcome of a standard HI assessment of activity limitation and participation restriction, but not with degree of HI and use of communication strategies. 相似文献
58.
59.
A rare vasoproliferative lesion: angiolymphoid hyperplasia with eosinophilia of the hand. 总被引:1,自引:0,他引:1
B D Krapohl H-G Machens B Reichert P Mail?nder 《British journal of plastic surgery》2003,56(2):168-170
Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vasoproliferative lesion of uncertain aetiology, involving the skin and subcutaneous tissue. The predilection of the tumour-like lesion is for the head and neck region. Radical surgical excision is still regarded as the most effective treatment. We present the case of a 33-year-old female with ALHE of the right hand. Preoperative MRI and angiography demonstrated involvement of the fourth and fifth rays, with complete occlusion of the ulnar artery, and a small lesion at the level of the metacarpophalangeal joint of the index finger. Complete tumour excision could not be achieved without resection of the fourth and fifth rays. One year postoperatively, there were no clinical signs of recurrence. The patient refused any further invasive diagnostic and follow-up examinations. Angiolymphoid hyperplasia of the hand is a rare disease, and patients should undergo early surgical treatment to achieve complete excision of the lesion. 相似文献
60.
F. Siemers Dr. med. R. Battermann Dr. med. J. A. Lohmeyer Dr. med. M. Kaun Prof. Dr. med. H.-G. Machens Prof. Dr. med. P. Mailänder 《Intensivmedizin und Notfallmedizin》2007,44(8):507-514
Geriatric patients represent a separate group in the treatment of burn injury regarding pathogenesis, pathophysiology and therapeutic procedure. Age-dependent changes of the skin, rising comorbidity and decreased reactivity in the context of trauma can lead to more serious processes. In the period from 1990 to 2001 in the burn unit of the University Hospital Schleswig- Holstein, Campus Luebeck, 53 patients with an age of more than 60 years were treated. The mean age of the 27 women and 26 men was 76 years (60–102 years), with on average 33.2% of the body surface (5–95%) being concerned by thermal injury, 25 patients had severe inhalation injury, 77.4% of the patients suffered third degree burn injuries. At the time of admission, the mean ABSI Score (Abbreviated Burn Severity Index) was 12. Relevant additional diseases were coronary heart disease (n=32), heart insufficiency NYHA III-VI (n=27), arterial hypertonus (n=25), COPD (n=11), adiposity with BMI>30 (n=14) and chronic alcoholism (n=9). Twenty-two patients were treated by early operative intervention (early necrectomy: 0–4 days following the accident), 13 of these patients survived. In 17 cases, the first operative procedure could take place only at a later date; 14 patients were not operated due to early death. Twenty-six patients (49%) developed pneumonia. The total morbidity amounted to 26 of 53 patients. A total of 19 injured with a burn index more than 80 survived. From these 19 survivors 9 patients had an index of more than 100. Usual indices as the Zellweger Index and the ABSI Score are not adequate to determine prognosis about thermal injuries in the elderly. 相似文献